Since the development of the biomechanically more advantageous locking plates and locking intramedullary nails, the surgical indications for ORIF have been extended to elderly patients with osteoporosis. Surgical treatments for PHFs include open reduction and internal fixation (ORIF), closed reduction and internal fixation (CRIF), hemiarthroplasty (HA), and reverse shoulder arthroplasty (RSA) (Fig. The proportion of cases with PHFs undergoing surgical treatment has been growing over recent years, and in New York State approximately 30% of PHFs were treated surgically in 2010. Although nondisplaced or minimally displaced PHFs can be treated nonoperatively, displaced or unstable PHFs often require surgical treatment. Proximal humeral fractures (PHFs) account for approximately 5% of all fractures, and are the third most common fractures in patients older than 65 years following hip and distal radius fractures. Overall, our findings indicated that surgical treatment of proximal humeral fractures, particularly by open reduction and internal fixation, continues to increase in terms of type of arthroplasty procedure, the rate of cases treated with reverse shoulder arthroplasty tended to increase. The proportion of reverse shoulder arthroplasty was shown to increase especially in patients aged 80 years or older. In terms of type of arthroplasty procedure, the rate of cases treated with reverse shoulder arthroplasty tended to increase significantly each year, from 8.2% of the overall arthroplasty procedures in 2008 to 52.0% in 2016 ( p < 0.001). The rate of cases treated with open reduction and internal fixation tended to increase each year, from 71.5% of the overall surgeries in 2008 to 85.6% in 2016 conversely, the rate of cases treated with closed reduction and internal fixation tended to decrease from 19.9% in 2008 to 4.5% in 2016. The overall operative rate for proximal humeral fractures increased steadily from 24.6% in 2008 to 36.8% in 2016 ( p < 0.001). ResultsĪ total of 69,120 proximal humeral fractures were identified from 2008 to 2016. International Classification of Diseases, 10th revision codes and procedure codes were used to identify patients aged ≥65 years with proximal humeral fractures. We analyzed the Korean Health Insurance Review and Assessment Service database from 2008 to 2016. The objective of this study was to investigate the national surgical trends in elderly patients with proximal humeral fractures in South Korea. It is known that there are large regional variations in treatment methods for the management of proximal humeral fractures.
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